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4 September 2010 



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www.chemistanddruggist.co.uk 
4 September 2010 



EXCLUSIVE 



The great stocks drought 



Shortages hit new low 

Patient hospitalised by 
drug delay page 7 

Analysis: getting the 
chain flowing again 




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Have your say on C+D's news. Email us at: 
haveyoursay@chemistanddruggist.co.uk 



COMMENT 



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£the sector has 
gone from 
respected 
witness to chief 
suspect as the 
recriminations 
start on the 
latest round 

OF STOCK 
SHORTAGES 9 



Patients howling in despair after 
being told they must wait days for 
life-saving medicines. It's a 
harrowing scene you might expect 
to encounter in some war-torn, third 
world country. Yet it's something 
you'll witness every day in UK 
pharmacies in 2010 

The results of C+D's Stock Survey 
shame the NHS (p7). Over 40 
pharmacists give specific examples 
of patients' health suffering because 
they simply can't get hold of the 
prescribed drug. From geriatric 
patients forced to catch three 
separate buses to track down their 
medicine to fits in epilepsy sufferers 
leading to hospital admissions. 

Pharmacists should be applauded 
for speaking out on the human price 
being paid for the meltdown in the 
medicine supply chain. But instead, 
the sector has gone from respected 
witness to chief suspect as the 
recriminations start on the latest 
round of stock shortages. 

You don't need to be Perry Mason 
to work out that the charge would 
centre on parallel trading. The 
practice is cited by manufacturers 
and the government as a root cause 
behind the shortages exposed by 
C+D's Stock Survey (p6). Parallel 
trading is our very own kryptonite. 
Just when the sector is starting to 
assert itself as a serious healthcare 
provider, someone will sling a 
parallel trade comment our way and 
watch pharmacists cower. 

Yet it really is about time we 
quashed the bunkum over parallel 
trading. Once upon a time not so 



long ago the practice was the apple 
of the government's eye. 
Entrepreneurial pharmacists kept the 
NHS drugs bill down when the 
pound was strong It smacks of 
hypocrisy then that a practice once 
revered is now so reviled because it's 
become less favourable to the UK 
Exchequer. 

Parallel trading has also split 
opinion over ethics. Opponents say a 
sector bound by a code of ethics to 
put patient safety first can't then 
ship life-saving drugs away from 
these shores. The debate will rage 
on, but we should remind the wider 
world this is not a commonplace 
activity for most pharmacists. 

Less than one in 10 in the sector 
parallel trades, according to 
estimates. Presumably with their 
high tech distribution models and 
data capture systems, big pharma 
can pinpoint who the traders are. 
But it doesn't seem to be happening 

Feedback from the frontline 
suggests quotas are rigorously 
enforced. Getting hold of just a 
couple of extra packs of medicine 
can turn into a lengthy and 
humiliating interrogation. Trust 
appears to have broken down here 
between pharmacy and big pharma. 
It can change and the C+D Senate 
has some suggestions as to how we 
start the reconciliation (p26). 

Do so by establishing an honest, 
open dialogue then perhaps next 
year's C+D Stock Survey will reveal a 
more positive picture for us all. 

Max Cosney, News Editor 



6 Supply chain crisis, C+D survey reveals 

7 Patients suffer as result of shortages 

8 Oxford pharmacy death threat terror 
10 C+D Senate calls for better pharma links 
12 £500k campaign marks 60th birthday 
14 Analysis: what next for supply chain? 

16 Xrayser and Duncan Rudkin 

17 Terry Maguire and Finance Zone 
28 Classified 



18 Update: breastfeeding 

Common problems and how to overcome them 

20 Practical approach 

Causes and treatment of cracked heels 

22 Category focus: women's health 

Are you equipped for this lucrative market? 

26 The C+D Senate 

Building a relationship with big pharma 



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04.09.10 5 



NEWS 



Shortages soar as supply 
chain hits crisis point 

EXCLUSIVE At least seven working days a year being spent per 
pharmacist chasing branded drugs, C+D Stock Survey 201 reveals 



Max Cosney 

max .gosney @u bm .com 



Stock shortages have soared with 
high profile government talks to 
solve the crisis making no impact at 
grassroots level, the C+D Stock 
Survey 2010 has revealed. 

Over 80 per cent of pharmacists 
said getting hold of branded 
medicines was tougher than ever. 

Sinemet, Femara, Zyprexa and 
Cipralex were named among the 
most difficult to obtain. 

Nearly 90 per cent of pharmacists 
spent over an hour a week trying to 
source key medicines. The figure 
equates to seven working days a 
year spent chasing drugs. 

Most said they were braced for 
worse to come in 2011, with 60 per 
cent predicting wide shortages. 

The findings come despite an 
emergency stock summit called by 
the health secretary this March and 
six months of talks between the 
Department of Health (DH), 
manufacturers, pharmacy bodies 
and wholesalers. Eighty six per cent 
of respondents branded these 
efforts to solve shortages 'poor'. 



Some respondents said more than 
50 drugs were still out of stock at 
their wholesalers. 

Pharmacists vented their 
frustration on manufacturers over 
the shortages. The quota systems 
operated by big pharma were 
unreasonable and unhelpful, said 
Bakul Patel of Kamsons Pharmacy in 
Rainham, Essex. 

He said: "Some of them are 
ridiculous. You have to phone up and 
have your integrity questioned to 
get hold of a few extra boxes. If I'm 
doing something wrong then tell me 
about it - don't inconvenience my 
patients for no reason." 

Manufacturers have blamed 
parallel trading of UK medicines to 
the EU as the cause of the shortages. 

Mr Patel branded the defence a 
smokescreen. "Parallel trading has 
gone on for years, but while we were 
a net importer nobody minded. 

"European pharmacists never 
suffered rationing like this when 
they were net exporters." 

However, the government 
reiterated the link between stock 
shortages and parallel trading in its 
statement on the findings. 



Pharmacy minister Earl Howe 
said: "We are taking forward the 
programme of work agreed earlier 
this year at the summit to tackle 
supply issues that arise due to a 
weak pound sterling and the 
resulting increase in UK medicines 
exported to Europe." 

Manufacturers whose medicines 
feature on the PSNC shortages list 
also cited parallel trading as the 
cause of stock problems. 

Novartis told C+D: "Novartis 
acknowledges the work of the 
majority of pharmacists in helping to 
manage the current medicine 
shortages... differences in medicine 
prices between the UK and other 
parts of Europe can lead to a small 
number of businesses and 
individuals ordering medicines to 
resell overseas for profit." 

AstraZeneca said emergency 
arrangements would provide stock 
"within around 24 hours". 




See more results from the C+D Stock Survey 

www.chemistanddruggist.co.uk and analysis page 14 



The supply chain verdict 



'A 



Government view 

"Medicine 
supply 

problems can 
occur for a 
number of 
reasons, 
such as 

manufacturing 
Idi&k JM I problems, 

difficulties in 
obtaining raw materials, 
regulatory issues, changes to 
manufacturers' distribution 
systems and from parallel trade. 

"The introduction of 
contingency arrangements and the 
efforts of pharmacists and others 
in the supply chain helps ensure 
that patients receive the 
medicines they need." 
Earl Howe, 
pharmacy minister 




Wholesaler view 

"The results of 
your survey are 
shocking and an 
indictment of 
what used to 
be an efficient 
and resilient 
medicines supply 
system for 
patients, doctors 
and pharmacists. Many of us have 
been warning that this situation 
might arise for some time now, but 
the regulators and authorities do not 
have the powers to intervene unless 
there is either a cost to the NHS or 
patient harm is proven. Now is the 
time for all of us who care about the 
supply chain to make our case, 
before it is too late." 
Martin Sawer, 
executive director, BAP W 




Pharmacy view 

"Results of this 
survey on 
medicines 
shortages are 
extremely 
concerning. And I 
recognise that 
pharmacists will 
be spending 
precious time 
each day trying to source medicines 
- an activity which takes them away 
from direct patient contact and is 
completely unsustainable. 

"At present, the effect on patients 
is being mitigated by the 
tremendous efforts of pharmacists. 
However, this additional workload 
will be putting huge pressure on 
frontline staff." 
Helen Gordon, 
RPSGB, chief executive 




ABPI view 

"The ABPI also 
believes that 
the problem is 
worsening, 
despite joint 
efforts by the 
supply chain 
forum, and 
we have 
highlighted to 
government that fresh action is 
needed. Feedback from member 
companies confirms that 
pharmacies continue to order 
medicines that are in short supply 
using emergency arrangements. 
It is not uncommon to receive 
requests that may be pharmacists 
trying to build contingency stock 
or divert overseas." 
Richard Barker, 
ABPI director general 



6 Chemist-:-Dr 



04.09.10 



Distribution 
deals to blame 




Patients suffering as 
a result of shortages 



Branded medicine shortages have 
triggered distress and suffering in 
patients with life-threatening 
illnesses, the C+D Stock Survey 2010 
has found. 

Forty two pharmacists gave their 
accounts of patient trauma ranging 
from "anxiety and distress" to 
hospital admissions. 

Parkinson's and cancer sufferers 
were among the worst hit as several 
pharmacists reported difficulty 
sourcing Sinemet and Femara. 

Of the more than 200 
pharmacists surveyed, 27 per cent 
had known a patient whose health 
had suffered as a result of difficulty 
sourcing a medicine. 

Over seven out of 10 respondents 
reported they were very concerned 
that their patients had been affected 
by drug shortages. 

The results of the survey also 
showed 93 per cent of pharmacists 
have had to ask a CP to change a 
prescription because of problems 
sourcing a drug. 



Head of policy at Macmillan 
Cancer Support Mike Hobday said: 
"Having to wait for medication is an 
additional worry that cancer 
patients do not need." 

National education advisor for 
Parkinson's UK Daiga Heisters said 
the charity had encouraged patients 
to write to the director of Sinemet 
manufacturer MSD over shortages. 
MSD has warned over a global 
shortage because of a change in the 
source supply of the medicine. 

Ms Heisters said: "People are still 
calling to say they can't get hold of 
Sinement, and in some cases the 
generic as well." 

Femara manufacturer Novartis 
said it was supplying "critical" 
medicines direct after consulting 
with stakeholders. 

MSD said it was in constant touch 
with the Department of Health, 
doctors, pharmacists and patient 
organisations on this matter "to 
advise them of the shortage and 
alternative measures" HF 



Manufacturer supply deals designed 
to shore up medicine stocks have 
actually made it harder for 
pharmacists to get hold of drugs. 

Over 70 per cent of pharmacists 
said it was harder to source 
products from pharma firms running 
distribution schemes, the C+D Stock 
Survey 2010 found. 

Only 6 per cent said supply deals 
had improved access to medicines. 

More than 20 manufacturers have 
launched bespoke supply 
arrangements since 2007, with 
most citing improved medicine 
supply to patients as a key reason 
to change. 

Thirteen of the 19 manufacturers 
whose products either appear on 
shortages lists or are most 
frequently linked to shortages 
according to PSNC operate a supply 
model. 

Three quarters of pharmacists 
said they waited three days or more 
for emergency stock to be delivered 
from a manufacturer, according to 
the C+D survey. MC 



How shortages 
have hit patients 



"We have had problems getting 
hold of Femara, and the woman 
was not at all happy. She was 
not angry, but worried, and we 
had to scrounge half a packet 
off another one of our stores. 
You now have to fax the details 
of the prescription off to 
Novartis, so it's very hand-to- 
mouth." 

George Romanes, 

George Romanes Pharmacy, 

Berwickshire 

"One of our patients needed 
Spiriva 2.5mg Respimat for his 
COPD, and though there are 
other versions available he 
couldn't use the inhaler. He 
ended up having to call an 
ambulance and go into hospital 
when he experienced breathing 
problems as a result of his drug \ 
running out" 
Yasirali Pirmohamed, 
The Co-operative Pharmacy, 
Birmingham 

How are you coping? Are your 
patients affected or is there no 
problem? Share your stories 
max.gosney@ubm.com 



NEWS 

:k talk 



"I'm annoyed 
at the attitude 
of the 

manufacturers 
It was well 
known about 

five or 10 years ago there were a lot 
of parallel imports on the market. 
For them to cry wolf and say it's 
wrong for that to happen the other 
way round where we are supplying 
the drugs into Europe smells of a lot 
of hypocrisy." 
Neeraj Salwan, 
Salwan Pharmacy, Johnstone 

"I'm extremely 
annoyed and 
frustrated 



because 
although there 
has been much 




talk about it right up to MP level, 
there is a lot of talk and very little 
action. It has now become such a 
crisis point that we're losing out on 
huge amounts of money from it just 
through man hours." 
Raj Rohilla, 

Richmond Pharmacy, Surrey 

"It increases the 
workload no 
end, and the 
loser is the 
patient who has 
to wait longer 
than the norm. It's a lose-lose 
situation." 
Raymond Hall, 

Raymond C Hall Pharmacy, Hull 

"We can't be 
expected to 
know where 
every single 
product comes 
from, we aren't 
getting answers on the phones, 
we have to wait and the phones 
are constantly busy. The whole 
thing is a big time wasting exercise 
and we're still getting 90p for 
dispensing it." 
Brian Deal, 

Ashwell Pharmacy, Hertfordshire 

"We're trying to 
improvise as 
much as we can 
when we can 
double up on 
strength, but its 
very frustrating for us and the 
patients." 
Lorraine Moore, 

Rowlands Pharmacy, Sunderland 








04.09.10 



7 



Reduce the risk of crime in your pharmacy 
www.tinyurl.com/pharmacycrime 



talk 

Has your PCT cut any 
enhanced services in 
the past month? 




"No, not as far 
as I am aware. 
We haven't had 
any notification 
of any services 
being cut." 
Susan Youssef, 
Dean & 
Smedley, 
Littleover, Derby 



"We don't do 
many services 
anyway. None 
have been cut, 
though we don't 
do enough 
enhanced 
services to start 
with." 

Jazz Mann, Lloydspharmacy, 
Stoct ton Heath Warrington 

Web verdict 

Yes - smoking cessation and 
minor ailments 

Yes - but only one of the above 

23% 



Yes - smoking cessation, minor 
ailments and others B% 



No - no service cuts 



: .,• Worryingly, more 

than one in four pharmacists has 
already seen at least one enhanced 
service cut in their PCT recently. And 
for one in 12, the cuts have extended 
beyond smoking cessation and 
minor ailments. 
Next week's question: 
Did you get a longer break than 
usual over the August bank holiday, 
or did you have to work? Vote at 
www.chemistanddruggist.co.uk 




Death threat terror 
stuns Oxford pharmacist 

Vandalism, intimidation and arson attempts leave staff fearful 



Chris Chapman 

chris.chapman@ubm.com 

An Oxford pharmacist has been left 
fearing for his safety after a reign of 
terror that has seen death threats 
and vandalism at his pharmacy. 

Pupinder Chatora, of Woodlands 
Chemist in Oxford, said his life was 
threatened while at work on Friday, 
August 20. Then, that night, the 
pharmacy's lock was vandalised and 
white spirit poured through the door. 

Notes warning "you'd better 
watch your back", were left on his 
delivery van, and a dispensing 
assistant was threatened by two 
men while walking home. And on 
more than one occasion, spent 
matches have been left outside 
the pharmacy. 

The attacks come just weeks after 
C+D reported soaring levels of crime 
in London pharmacies (C+D, August 
14, p6) and follow calls for more 
protection for the sector. 

"It's scary," Mr Chatora said of his 
situation, expressing concern that 




Pupinder Ghatora: the cost of security measures could force him out of business 



the matches outside his pharmacy 
were an arson attempt. "If this store 
goes up, it will kill the students that 
live above us... the worst thing is 
that it happens when we're not here. 
It's cowardice, it's just cowardly." 

The pharmacy locks have had to 
be changed three times, Mr Chatora 
added. A private security firm has 
also been hired and electronic 



Pharmacies save £460m in 
advice, Finnish study finds 



Community pharmacists save 
healthcare systems hundreds of 
millions of pounds a year by giving 
patients health advice over the 
counter, an international pharmacy 
conference has heard. 

The finding follows promises from 
PSNC that it too is working to 
compile stronger evidence of the 
benefits of pharmacy services in 
England (C+D, August 28, p4). 

According to a survey of 197 
pharmacists in Finland, pharmacists 
helped avoid 6.2 million visits to a 
CP and 750,000 emergency visits a 
year by offering advice, improving 
adherence and correcting errors. 



Pharmacists also helped slash 
prescription numbers by 2.6 million 
a year and prevented 123,000 
inpatient nights in hospital in Finland, 
the conference of the International 
Pharmaceutical Federation in Lisbon 
heard on Wednesday. 

Dr Erkki Kostiainen, of the 
Association of Finnish Pharmacies 
(AFP), said: "Although some of the 
evaluations are based on the 
opinions and experience of doctors 
and pharmacists... I see no reason 
why these findings should not be 
applicable to other countries." 

The survey was carried out by the 
AFP and PricewaterhouseCoopers. CC 



shutters and CCTV installed to 
protect the pharmacy and its staff. 

"It's costing me a fortune - I can't 
survive any longer," Mr Chatora said, 
adding that customers had offered 
to contribute to security costs. 

A spokesman for Thames Valley 
Police confirmed there had been 
multiple incidents reported at the 
premises in the past week. 

Cost cuts at 
wholesaler AH 

Alliance Healthcare is consulting 
with staff over a number of cost- 
saving measures that could see more 
job losses at the wholesaler. 

Redundancies may occur where 
efforts are being duplicated but 
would form just one part of a larger 
strategy designed to cut costs, C+D 
understands. 

An Alliance Healthcare 
spokesperson said the wholesaler 
had advised employees of a decision, 
"to implement a number of cost 
saving initiatives across the business, 
which we believe will help to ensure 
our continued success in the current 
economic climate". ZS 



Duncan Rudkin: Life under the new pharmacy regulator 

C+D Keynote Conference at the Pharmacy Show 

October 10-11 The NEC Birmingham 
Register for your free ticket at www.chemistanddruggist.co.uk/thepharmacyshow 



04.09.10 






ESSENTIALS 

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NEWS 



a Get breaking news straight to your inbox 
www.chemistanddruggist.co.uk/register 




INVESTIGATION 

We reveal the good, bad and 
outright ugly side of PCT 
commissioning. See next week's 
C+D for more details. 

Co-op profits soar 

The Co-operative Pharmacy 
has reported operating profits of 
£18 million for the first half of 
2010 - a rise of 26 per cent. The 
rise was attributed to improving 
efficiencies and controlling 
distribution costs through the 
Co-operative Pharmacy's National 
Distribution Centre. 

Blackout warning 

Patients with heart disease or 
epilepsy may be missed because 
of spontaneous blackouts being 
assessed inadequately, Nice has 
warned. New guidance says 
patients experiencing a blackout 
should have a medical history 
taken and their vital signs 
checked, and be asked for the 
specific circumstances that 
occurred before, during and after 
the suspected blackout. 

MHRA recall alert 

The MHRA has issued an alert as 
Abbot Medical Optics (AMO) is 
recalling two lots of AMO 
Complete multipurpose solution 
over concerns faulty caps may 
mean the products are no longer 
sterile. The affected products are 
product code 93505, 360ml, lot 
number AH01072, and code 
93515, 240ml, lot number 
AH01225, both with expiry date 
April 2012. 

For more on the above stories see 
www.chemistanddruggist.co.uk 



C+D Senate calls for 
better big pharma link 

Relationship clouded by stock shortage issues, think-tank hears 



Hannah Flynn 

hannah.flynn@ubm.com 

Pharmaceutical companies and 
pharmacists need to put aside their 
differences and work together to 
ensure patient compliance, the C+D 
Senate has concluded. 

The relationship is clouded by 
issues such as stock shortages, 
Senators agreed. And manufacturers 
felt messages could get confused as 
there were so many voices in the 
community pharmacy sector. 

But both sides agreed positive 
steps could be taken. Medicines 



compliance could be an opportunity 
for a partnership, said Nick Lowen, 
director for commercial operations 
at GSK. Mr Lowen said: "Better use 
of medicines is going to be key to 
what the NHS wants to achieve." 

His views were echoed by Pfizer's 
commercial director Steve Poulton, 
who said: "One of the things we 
recognise is that where pharmacy 
can provide a route to better use 
of medicine then we definitely 
support that." 

However, the view was challenged 
by NPA chairman and pharmacist 
Ian Facer, who asked which party 



should make the first move in 
developing the new relationships. Mr 
Facer asked: "Should it be us going 
to them or them going to us 7 " 

Rowlands area manager Debby 
Crockford questioned the strength 
of pharmacy's relationship with drug 
manufacturers following stock 
problems. "There's a lot of anger in 
some areas over shortages," she said. 



Full C+D Senate report 
(p26), and see the video 
interviews online now 



Clinical debate C+D's Chris Chapman looks at the evidence behind the headlines 

Mixtard 30 - the concerns 




A few weeks ago I touched on 
several problems on the horizon in 
terms of diabetes care in the UK. 
Now the UK Clinical Pharmacy 
Association (UKCPA) has 
expressed concerns over one of the 
topics covered - the withdrawal of 
Mixtard 30 - and how it's going to 
hit patients and pharmacists. 

Mixtard 30 is an intermediate- 
acting human insulin, used by 
around 90,000 patients in the UK 
according to Diabetes UK. Earlier 
this year manufacturer Novo 



Nordisk announced the medication 
would be withdrawn from December 
31. However, the move is meeting 
resistance, with charities calling for a 
longer withdrawal period. 

Now UKCPA has weighed in with 
its concerns. 

The first problem is that the 
alternatives are not dose equivalent, 
requiring additional appointments 
for dose titration. Fortunately, 
guidance is available from UK 
Medicines Information (UKMI). Links 
to this information, which includes 
dose adjustment and administration 
advice, are available at www.chemist 
anddruggist.co.uk/cpdzone. 

The second of UKCPA's concerns is 
that the alternatives are more 
expensive, hitting drug budgets 
already squeezed in the recession's 
belt-tightening. For example, 
switching from Mixtard 30 to 
Humulin M3 vials would cost an 
additional £8.20. However, the cost 
of cartridges for a reusable pen 
device of the two insulins is the 



same: £19.08. So while costs may 
rise for some patients, the switch 
doesn't necessarily mean an 
automatic hike in price. 

The final concern raised by 
UKCPA is the use of an Innolet 
injecting device, which is useful 
for patients with visual 
impairment or manual dexterity 
problems. According to UKCPA, 
this could lead to a surge in 
demands on district nurses to 
help administer insulin to many 
patients currently independent. 

The concerns are all valid and 
issues community pharmacists 
should familiarise themselves 
with going forward. 

Some patients may already 
have begun their switch from 
Mixtard to an alternative, and 
doctors, patients and relatives 
may all ask pharmacists for 
advice. 

Chat with Chris on Twitter: 
www.twitter.com/CandDChris 



Julie Wood: How can you win over commissioners? 

C+D Keynote Conference at the Pharmacy Show 

October 10-11 The NEC Birmingham 
Register for your free ticket at www.chemistanddruggist.co.uk/thepharmacyshow 




10 Chemist Druggist 04.09.10 



everything you always wanted to know 
about pain but were afraid to ask 

enrol now for your free training 




Why Nurofen. The award winning Nurofen Academy of Excellence 
is back. It's your chance to find out absolutely everything there 
is to know about pain. Register now and be part of the 16,000 
strong army of pain experts throughout the country. Enrol 
now by emailing pharmacytraining@chemistanddruggist.co.uk 
(Subject: Nurofen Academy Enrolment). For any other queries 
call our helpline on 0207 921 8425. 



The 

Academy 

of Excellence 



Existing members should re-register using the same details above. 



PRODUCT NEWS 



Need to train a dispensary assistant? Benchmark is your solution 
www.chemistanddruggist.co.uk/stafftraining 



£500,000 for Astral campaign 



Dendron 
has 

announced 
that Astral 
all-over 
moisturiser 
is set to be 
the focus of 
a £500,000 
marketing 
campaign. 

The campaign will 
include magazine advertising, and a 
website upgrade including a loyalty 
club, according to the company. 




Dendron said that the 
company will develop product 
trials via its e-marketing 
database and through reader 
trials in magazines. 

The move follows the 60th 
birthday of the heritage 
product this month. 



Prices: £1.49/50ml; 
£4.19/200ml; £7.99/500ml 
Pip codes: 272-5224; 290-9398; 
025-3930 
Dendron 

Tel: 01923 205704 



Gaviscon goes strawberry 
flavour for Reckitt Benckiser 



Reckitt Benckiser has announced the 
launch of 
heartburn 
and 

indigestion 
remedy 
Gaviscon 
Strawberry 
Flavoured 
Tablets. 

Reckitt Benckiser is supporting the 
Gaviscon range in 2010 with a media 
spend of over £11 million, with a 
television campaign for the 
strawberry tablets from November, 
according to the company 

The product will be available in 





blister packs of 16 and 32 and 
'handy-packs' of 16. 
Gaviscon 
Strawberry Flavour 
Tablets contain 
sodium alginate 
250mg, sodium 
hydrogen carbonate 
133. 5mg and calcium 
carbonate 80mg 



aw 



Prices: £2.53/16; £2.81/16 handy 
pack; £4.44/32 

Pip codes: 356-0745; 356-1305; 
329-1309 
Reckitt Benckiser 
Tel: 0500 455456 



Senokot offers Comfort on TV 



Reckitt 
Benckiser 
has 

announced 
the launch of 
Senokot 
Comfort, a 
constipation 
treatment. 

The tablets have a dual effect as 
they relieve constipation and soften 
stools, according to the company. 

Reckitt Benckiser is supporting the 
launch of the product with a 
television advertising campaign 
starting in November. 




Senokot Comfort 

tablets contain 
a combination 
of ingredients 
including 
senna leaf 
105mg, 
purified 
sulphur 50mg, 
rhubarb extract 
25mg, and wood charcoal 180mg 

Price: £4.99/20 
Pip code: 355-9325 
Reckitt Benckiser 
Tel: 0500 455456 



Market focus 

• Skincare products, including 
suncare, were worth nearly 
£2 billion in 2009 - a yearly 
increase of 5 per cent. 

• The sector accounted for 27 
per cent of the total value of 
sales of toiletries. 

Source: Key Note Toiletries Market 
Report Plus 2010 



CoaguChek S 
off shelf soon 

Roche Diagnostics has announced 
plans to remove CoaguChek S test 
strips and controls from the market 
over the coming 18 months. 

The move is due to the significant 
increase in demand for the newer XS 
technology, the company says. 
Roche is offering an upgrade price 
for customers to move to the XS 
technology until November 30. 



Roche Diagnostics 
Tel: 0808100 9998 
www.coaguchek.co.uk 



Motilium gets fast melt formula 



domperidone 



McNeil 
Products 
has 

announced 
the launch 
of a nausea 
relief 
product, 
Motilium 
Instants. 

The product has the same 
indications as Motilium 10, but 
comes in a fast melt formula. This 
means there is no need to take them 
with water, McNeil says. 

The product contains 10mg 



motilium 

instants 



domperidone as 
maleate and a 
new indication 
of relief of 
nausea and 
vomiting of less 
than 48 hours 
duration was 
recently 
approved, 
according to the company. 



Nausea & Vomiting • 
Stomach discomfort 
Fullness & bloating 

instant melt tablets 1 



Price: £4.67/10 
Pip code: 356/2394 
McNeil Products 
Tel: 0808 238 9783 



Dermatology gloves launch 



Molnlycke Health Care has launched 
ready-to-wear glove product 
Tubifast Gloves with 2-Way Stretch 
Technology. The 
gloves are 
for use in 
wet or dry 
wrapping 
and 

for 

v dressing 
\ retention with 

jjp- multidirectional 

stretch, which allows 
greater freedom of movement 
and comfort, says the company. 
The gloves are available in four 
sizes and will replace the current 
Tubifast Gloves, which will be 



discontinued in the Drug Tariff from 
November 30. 

Prices: £9.94 

Pip codes: 357-1247/Adult M L; 
357-1254/Children M-L; 
357-1270/Child Small; 
357-1262/ Child Extra Small 
Molnlycke Health Care 
Tel: 0800 7311 876 
www.skincare-world.com 



General 

Pharmaceutical 

Council 




Look out for your 
GPhC information pack 



Check out what's on 
TV this week 

www.chemistanddruggist.co. 
uk/prodnews 



12 Chemist* Druggist 04.09.10 




When neuropathic pain makes 

diabetes hard to bear 




PREGABALIN 



Fast onset. Sustained relief. 



O Proven clinical efficacy in neuropathic pain 14 

O Rapid 24 and sustained relief in patients with painful 
diabetic peripheral neuropathy 245 

O Well-tolerated with a predictable pharmacokinetic profile 6 




Lytica * (pregabalinl Prescribing Information 
Reler to Summary ot Product Characteristics (SmPCI before 
prescribing. Presentation: Lyrica is supplied in hard capsules 
containing 25mg, 50m<j, 75mg, 100mg, 150mrj, 200mg or 300mg 
ot pregahalm Indications: treatment ol peripheral and rmitt.il 
neuropathic pain in adults Dosage: Adults 150 In 600mg per day 
in eithei two or three divided doses taken orally Treatment may be 
initiated at a dose ol 150mg per day and. based on individual patient 
response and tolerabilirv. may be increased to 300mg per day alter an 
interval of 3-7 days, and to a maximum dose ol 600mg per day after an 
additional 7-day interval. Treatment should be discontinued gradually 

dosage adiustment necessary, see SmPC Hepatic impairment 
No dosage adiustment required Elderly. Dosage adiustment 
required if impaired renal function Children end adolescents Not 

Contraindications 
substance or exopients Warnings and precautions: There 

angioedema Pregabalin should be li conti 

■ 

ts ol 

ther changes ol 

■ 



been reported in patients treated with anti-epileptic agents 
A meta-analysis of randomised placebo controlled trials of anti- 
epileptic drugs has also shown a small increased risk of suicidal 
ideation and behaviour The data does not exclude the possibility of an 
increased risk for pregabalin Patients should be monitored for signs 
of suicidal ideation and behaviours and appropriate treatment should 
be considered Patients land caregivers of patients) should be advised 
to seek medical advice should signs of suicidal ideation or behaviour 
emerge After discontinuation of short and long-term treatment 
withdrawal symptoms have been observed in some patients, insomnia, 
headache, nausea, diarrhoea, flu syndrome, nervousness, depression, 
pain, sweating and dizziness The patient should be informed about 
this at the start ot the treatment Concerning discontinuation of 
long-term treatment there are no data of the incidence and severity 

■ 

■ 

with caution in l 
il ilm may resolve the reaction Ability to drive and 

use machines: May affect ability to drive or operate machinery 
Interactions: Pregabalin appears to be additive in the impairment 

N 

Pregnancy and lactation 

■ 

is not recommended during treatment with Lyrica Side effects: 



Most commonly |>1/10) reported side effects in placebo- 
controlled, double-blind studies were somnolence and dizziness 
Commonly |>I/IOO. <1/10] reported side effects were appetite 
■ 

laxia, disturl 

■ 

conlusional stale, agitation. legal category - M 

Date of revision ■'■ Package quantities, marketing 

authorisation numbers and basic NHS price: .. 



request from 



Marketing Aulhonsation 



Further information is available on 



Adverse events should be reported. Reporting forms and information can be found at vvwv^ej.lowc.ardjjov yk. 
Adverse events should also be reported to Pfizer Medical Information on 01304 616161 



References: 1. 

4 



202-8 6.. 



NEWS ANALYSIS 



See results from the C+D Stock Survey 2010 
www.chemistanddruggist.co.uk 



Stock shortages: where does 
the sector go from here? 

As the C+D Stocks Survey 2010 reveals shortages are still wasting valuable time and affecting 
patients, Zoe Smeaton asks if we're any closer to a solution and how we might get there 




This time last year C+D's Stock 
Survey made national headlines as it 
revealed the distress shortages were 
causing, with some patients seeing 
their conditions deteriorate and 
even being admitted to hospital. 
Pharmacy leaders were shocked by 
the results and the industry was 
unanimous in its conclusion that 
something needed to be done. 

Yet fast forward a year and the 
2010 survey results seem all too 
familiar. Now 89 per cent of 
pharmacists say they spend at least 
one hour a week sourcing out-of- 
stock medicines - in 2009 the figure 
was 90 per cent. And after 89 per 
cent of pharmacists were "very 
concerned" patients would be 
affected by stock shortages last year, 
71 per cent now say they are very 
concerned this has happened. 

Pharmacists are certainly 
convinced things have not improved, 
as 82 per cent of those responding 
to the survey told C+D it had been 
harder getting hold of medicines in 
the last 12 months than in 2009. 
And industry leaders including the 
NPA and British Association of 
Pharmaceutical Wholesalers 
(BAPW) agree. 

Perhaps most disappointing about 
this is the fact that, on paper, progress 
has been made and improvements 
should have been seen. The subject 
has been hotly debated with a range 
of possible solutions put forward, 
including the BAPW's suggestion 
that legal duties of supply are 
imposed on the supply chain. In 
March, the Department of Health 
(DH) held an emergency summit on 
the matter at which stakeholders 
from across the supply chain agreed 
to co-operate and adopt a range of 
measures to resolve the situation. 

Furthermore, since the summit, 
C+D has reported that the 
department has been holding 
secretive talks with individual 
manufacturers in an attempt to 
resolve the crisis. But unfortunately 
all the talk seems to be just that, and 
benefits still aren't being seen on the 
ground. As Andy Murdock, pharmacy 
director at Lloydspharmacy, says: "It 




"We have carried out a stock shortages audit before 
and we're going to it again now because we suspect 
from anecdotal feedback that the situation hasn't 
improved. It's awful for some patients. We need a 
robust contingency supply and we haven't got it." 
Mark Stone, 
C pharmacist, Devon LPC 

Stock shortages are still a huge problem. If I'm 
honest, it doesn't feel much worse than last year, 
but that's not to say that's a good thing. I was 
hoping it would have improved by now." 
Keith Howell, 
pharmacy manager, 
Delmergate Pharmacy, Kent 



is a concern that we have yet to see 
any implementation following the 
ministerial summit in March." And 
Stephen Fishwick, head of external 
communications at the NPA, notes: 
"Talk is not enough". 

But is there anything more the 
sector can do to help or to force a 
resolution to the problem? 
Pharmacists are already doing an 
excellent job. As Helen Gordon, chief 
executive of the RPSCB, recognises: 
"The effect on patients is being 
mitigated by the tremendous efforts 
of pharmacists." But while the 
professional bodies might recognise 



the impact on the sector, it needs 
more than that to bring change. 
Importantly, the BAPW points out: 
"The regulators and authorities do 
not have the powers to intervene 
unless there is either a cost to the 
NHS or patient harm is proven." 

It seems obvious that patients are 
affected. Stories from the Stock 
Survey make for shocking reading as 
patients have been left without 
medicine for weeks at a time. The 
BAPW warns this could eventually 
increase costs for the NHS, but to 
the government the problem might 
not seem so obvious. 



Professor David Cousins, head of 
patient safety for medication and 
medical devices at the National 
Patient Safety Agency (NPSA), 
agrees omitted or delayed 
medicines, which can be caused by 
shortages, are a "major risk to 
patient safety". But he also warns: 
"Although the NPSA is aware that 
medicine shortages are increasing, 
the National Reporting and Learning 
Service receive few patient safety 
incident reports relating to omitted 
and delayed medicines from 
community pharmacists." 

It is hardly surprising that 
pharmacists are choosing not to 
spend time reporting incidents given 
the strain already on the sector, but 
without the collation of this vital 
evidence it may be impossible to 
convince the government just how 
much harm the situation is causing. 
And if reporting the problems forces 
a solution, it might just be worth the 
investment. Perhaps it could even be 
used to help obtain financial 
compensation for pharmacy's 
efforts. As Faisal Tuddy, commercial 
manager on Asda's pharmacy team 
says: "The contract negotiations 
between PSNC and the DH should 
fully consider the impact of these 
costs to pharmacy in the final 
settlement." 

Given all the work done on 
the issue so far, changes from the 
DH and elsewhere should be 
forthcoming. As Mr Fishwick says, all 
the talk should have served to give a 
more rounded appreciation of the 
problem and so eventually lead to 
some practical improvements in 
managing the supply chain. 

But to ensure that happens, it 
could be down to pharmacists 
and patients to start making more 
noise about the problem. C+D has 
already had reports of some going to 
their MPs about the issue, which 
might help raise awareness, and 
reporting the incidents could be 
another good step. 

As the BAPW concludes: "Now is 
the time for all of us who care about 
the supply chain to make our case, 
before it is too late." 



14 Chemist+Druggist 04.09.10 





Insightful 

w training courses 
Supporting pharmacy success 



Enhancing 

patient care 






Pfizer commitment 
to pharmacy 

As part of a healthy partnership"' our commitment is to 
listen to you, the community healthcare experts. We want 
to understand the professional issues facing community 
pharmacy so that when we act to develop support and 
training, it meets your professional development needs, 
helping you and your pharmacy succeed. 

Our MUR workshops have proved successful and we are 
continuing to develop further "soft skills" training to help 
you counsel patients, implement pharmacy services and to 
help grow your pharmacy. 

For the most up-to-date details on our "soft skills" 
meetings please visit www.pharmacymeetings.co.uk 
(insert code R948 on first page). 



J 



Listening to pharmacy 



a healthy 
partnership™ 

HP 0353. Date of preparation: May 2010. 



OPINION 




Looking for a better return on my money 




"AFTER AROUND £8,000 IN 
FEES, I FEEL I HAVE RECEIVED 
LITTLE IN RETURN BUT A 
SOCIETY MORE LIKE THE 
NATIONAL TRUST THAN THE 
NATIONAL HEALTH SERVICE" 



As a pre-reg student I would look at my tutor's 
RPSCB certificate with envy and admiration. It 
was a large, old-style certificate written by 
Dickensian scribe with a quill and therefore 
illegible, but you knew the owner was a person of 
rare and important abilities. 

I imagined registration as an ancient and 
hallowed ceremony, flames from braziers dancing 
through smoke of incense, the Society president, 
resplendent in flowing robes, hands me the scroll 
of alchemy, attesting that I had reached the level 
of journeyman apothecary. What I got was a man 
in a shiny suit, and a small plain A4 certificate that 
looked as if it came from WHSmith. 

This came to mind as I read last week's C+D. 
Not the articles about CP systems taking over 
Rx Systems (a metaphor for our future, perhaps) 
but the footnote: General Pharmaceutical Council 
- four weeks to go - made me wistful for the 
old RPSGB. 

There was no active branch in my area, so my 
only contact with the Society was the annual 
demand for fees, and the weekly delivery of the PJ. 
Like most pharmacists, I either left it in the 
wrapper, or turned to the jobs page and Statutory 
Committee reports. 

It wasn't until I moved to take on my own 
pharmacy that I really started to understand how 



the Society worked. Deciding to change the name 
to Xrayser Pharmacy, I thought we'd take a lesson 
from the pharmaceutical industry about how to 
promote, so I called professional standards at 
Lambeth and asked about giving out pens and mugs 
bearing our new name. There was a stony silence, 
before the voice on the other end said: "You want 
to put the name of your pharmacy... on a mug?" 

"Well, no, not a mug exactly," I backtracked. "I 
was really just phoning for some advice." 

"Ah, no, I can't tell you what you can or can't do. 
But if there's a complaint, we will investigate." 

And I guess that sums it up. After probably 
£8,000 in registration fees, I feel I have received 
little in return but a Society reactive, regressive, 
protectionist, more like the National Trust than 
the National Health Service. So I shed no tears to 
see the old world replaced by a new order, for the 
standing of a profession is down to the members, 
not any organisation. Let's hope the leadership 
body will take us places the Society could not. 



Do you believe the PLB will offer 
what the Society could not? 



haveyoursay@chemistandruggist.co.uk 



Upholding standards and trust in pharmacy 



As pharmacy gears up for the 
transfer of regulation, the CPhC has 
confirmed that its new corporate 
strapline will be "Upholding 
standards and public trust in 
pharmacy". This is a summary of 
what the organisation is for. So 
what's the thinking behind it 7 
Point 1: it's not about us. The words 
have been chosen because they 
encapsulate the impact that the 
CPhC is aiming to have in the world 
of pharmacy, rather than what 
happens at 129 Lambeth Road. 
Point 2: standards are at the heart 
of everything we do. Registration, 
quality assurance, CPD and fitness to 
practise are all a means to an end. 
The outcome of what we do has to 
be that the right standards are being 
delivered to and for patients. 
Point 3: it's not about the bare 
minimum. As a statutory regulatory 
body it is right that we have 
responsibility for assuring the core 
standards of proficiency, practice 
and conduct within the profession, 
and the equivalents for registered 
pharmacy premises. But standards 



that don't move forward risk going 
backwards. By committing to 
"upholding" standards we also 
recognise that we have an 
opportunity and responsibility to use 
regulation in a smart way to support 
positive improvements in patient 
safety and in the quality and 
effectiveness of care and services. 
Point 4: people trust pharmacy. 
Public trust is essential, it's invaluable, 
but it can also be vulnerable, and it 
needs to be justified. The public have 
high levels of trust in health 
professionals. The public also assume 
somebody somewhere is making 
sure this trust is not misplaced, 
because the standards and quality 
assurance are there to underpin the 
trust. As an independent regulator, 
the GPhC has the added advantage 
that it can offer assurance to back 
up public trust. 
Point 5: we're talking about 
professional pharmacy in the 
broadest sense. We will be 
regulating registered pharmacy 
premises and registered pharmacists 
and pharmacy technicians, whether 



they work in community pharmacy, 
hospital, primary care, management 
roles, research, academia or 
anywhere within a very broad and 
inclusive definition of 'pharmacy'. 

The strapline upholding standards 
and public trust in pharmacy 
underscores the very reason for our 
existence. It's why the GPhC gets out 
of its corporate bed in the mornings. 
But we cannot achieve these aims 
alone. In all these themes there is 
common ground between us as the 
regulator and you, the professionals. 
We want to work with you to uphold 
the standards you aim to maintain 
within pharmacy, and the trust that 
the public place in you. 
Duncan Rudkin is chief executive 
and registrar of the CPhC 



Will an independent 
regulator benefit 
pharmacy? 



haveyoursay@ 
chemistandruggist.co.uk 




"THE STRAPLINE 
UNDERSCORES THE 
VERY REASON FOR 
OUR EXISTENCE. 
IT'SWHYTHE GPhC 
GETS OUT OF ITS 
CORPORATE BED IN 
THE MORNINGS" 



16 04.09.10 



What do you think? 

haveyoursay@chemistanddruggist.co.uk 



The Conservatives are making me sick 



The people wanted a new 
government and now they've got it. 
It's a coalition, yet ironically it's 
more like a Chinese government 
with the Conservatives the central 
committee and the Liberal 
Democrats there only to take 
responsibility for distasteful policies 
and able only to agree; not to do 
anything. Be clear, the big ticket 
event of this parliament - the 
emergency budget - is not about 
tackling the country's deficit, it is 
merely an announcement of the 
return to Conservative values. 

The hypocrisy was palpable as the 
Chancellor got to his feet promising 
to recharge the public coffers 
depleted by Labour in its 13-year 
redistribution of wealth. I know I am 
sounding positively Marxist and a 
touch petty, but lost in all of George 
Osborne's budget hype was the fact 
that, in a time of dire financial 
problems, duty on cigarettes and 
alcohol were left untouched. This 
cannot be an accident since duty 
increases on fags and booze are how 



most governments get by. Indeed 
for many of my patients there was 
something to celebrate; a promised 
hike in duty on cider was scrapped 
altogether. 

Public health should not be party 
political but the Conservatives do 
not appear to appreciate that public 
health is inextricably linked to poverty, 
education, housing, nutrition, etc 

The plan to remove the Food 
Standards Agency (FSA) and more or 
less hand food regulation over to the 
food industry is bad enough, but the 
Conservative-supported broadside in 
the European Parliament on food 
labelling regulations was a shocking 
intervention. 

The FSA and health charities had 
hoped the traffic light food labelling 
scheme would be introduced 
Europe-wide but following intense 
lobbying by major food 
manufacturers, and support from 
the Conservatives, it was thrown out 
by the European parliament in 
favour of guideline daily amounts, a 
food labelling scheme that even 



someone with a PhD would find 
difficult to understand. As a society 
it is a fact that we are getting fatter 
and this is making us sicker 
Therefore laissez faire for the junk 
food industry is certainly not going 
to reduce the prevalence of type 2 
diabetes. 

The Conservatives denied the 
existence of social inequalities in 
health back in the 1980s when the 
Black reports and the north south 
divide first unmasked the issue. So it 
is such a tragedy that now, rather 
than having changed their views, 
they are adopting and supporting 
the very policies that created health 
inequalities in the first place. The 
Conservatives are making me sick. 
Terry Maguire is a community 
pharmacist in Northern Ireland 



Are Tory policies 
promoting inequality? 




haveyoursay@ 
chemistandruggist 



"IN ATIME OF DIRE 
FINANCIAL 
PROBLEMS, DUTY ON 
CIGARETTES AND 
ALCOHOL WERE LEFT 
UNTOUCHED.THIS 
CANNOT BEAN 
ACCIDENT" 



Finance Zone 



The Finance Zone 

PART 8: When to expand - and raising finance. 
Richard Baker explains what you need to consider 



The decision as to whether to 
expand your business is a significant 
one, but when is the right time? The 
four key points that indicate it is the 
right time to expand are: 

• the right acquisition opportunity 
has presented itself to you 

• the acquisition fits in with your 
strategy for your business 

• you are in a position to raise 
finance without putting strain on 
your existing business 

• you have sufficient time and 
resources to manage the acquired, 
as well as the existing, business. 

The ideal acquisition opportunity 
is a business you know already. 
Knowing the business owner and the 



area in which it operates gives you a 
huge advantage in deciding whether 
the opportunity is right for you. If 
you don't have this knowledge it's 
not a major problem, but it does 
mean more research and homework. 

An important point that shouldn't 
be underestimated is whether you 
have sufficient time and resources to 
manage the combined business. If 
you are short of time to manage the 
business you have, you need to 
seriously consider whether you need 
further help or manpower to cope 
with the combined business - and 
the impact of this on your finances. 

Assuming you have found the 
right opportunity, the next step is 



The C+D Finance Zone 

Call 0800 328 7270 to talk to a NatW 
advisor (quoting 'C+D') or to make an 
appointment with a NatWest pharma 
specialist relationship manager 
www.chemistanddruggist.co.uk/fi 



Supported by 



A NatWest 



Helpful Bonking 




Richard Baker: draw up a business plan 
to support your acquisition 



raising the finance. When 
approaching any financier you will 
need to have prepared forecasts and 
a business plan to support your 
decision to pursue the acquisition. 
You will save money on professional 
fees if you obtain as much financial 
information on the target business 
as you can. 

You may decide to prepare 
forecasts and a business plan 
yourself, but a good accountant will 
be able to review these and make 



some constructive observations, 
which will help you to present the 
information in the format the 
financiers require. 

When working on the figures, 
remember that the structure of the 
acquisition could impact on the 
funds you need. For example, in 
certain situations you will not 
receive any payments from the NHS 
for two months after you acquire the 
business and this must be factored in. 

The credit crunch has meant that 
it is much more difficult to raise 
finance than previously and it may 
mean that you have to consider a 
number of alternative options in 
both the provider you use and the 
type of finance you need. For 
example, a number of providers now 
offer finance secured on your 
outstanding NHS income. The 
decision process from the financiers' 
point of view is now generally much 
longer so it's important not to leave 
this until last on your to-do list. 
Richard Baker is a partner at 
accountancy firm Horwath Clark 
Whitehill 

Horwath Clark Whitehill 

NEXT MONTH 
Pharmacies and VAT 



17 



ZONE 



CLINICAL CLINICAL BUSINESS PROFESSIONAL 

▼ 18 Breastfeeding ^ 20 Cracked heels ^ 22 Women's health ^ 26 Working with big pharma 



Breastfeeding 

Establishing feeding and the problems that may occur 



Supported by 



GENUS PHARMACEUTICALS 



Katharine Gascoigne MRPharmS 

The Department of Health (DH) and World 
Health Organization (WHO) recommend babies 
are exclusively breastfed for the first six months of 
life. Indeed, the WHO states it is now certain 
breastfeeding decreases childhood mortality and 
has benefits that extend into adulthood, and 
recommend that with appropriate 
complementary foods infants should continue to 
be breastfed up to two years. Breast milk provides 
all the energy and nutrients an infant needs for 
the first months of life and continues to provide 
up to half a child's nutritional needs during the 
second half of its first year, and up to a third 
during the second year. 

In order to establish and sustain exclusive 
breastfeeding for six months, WHO and UNICEF 
recommend: 

initiation of breastfeeding within the first 
hour of life 

a no additional food or drink, including water, 
is given 

the baby is fed on demand (ie as often as 
the child wants) 
bottles and pacifiers (dummies) are not used. 



Once the baby and placenta have been delivered, 
the levels of oestrogen and progesterone decline 
rapidly. Prolactin released from the pituitary gland 
stimulates the production of milk in the breasts, 
which are made up of adipose and secretory 
tissue. The fatty tissue supports and protects 15 to 
25 lobes made up of individual alveoli, which 
produce milk and swell to hold it until required. 

As well as prolactin, the pituitary gland releases 
oxytocin when the baby touches the breast, which 
stimulates contraction of the alveoli and forces 
milk into ducts that drain to the nipple. This is 
called the let-down reflex. Let-down may also 
occur when the mother hears her baby's cry or 
when they think about the baby or feeding. 
Different women feel the let-down reflex in 
different ways. Some feel a slight tingling, some 
feel pressure and discomfort while others feel 
nothing at all. 

For a few days after birth the breasts produce 
the first milk, which is called colostrum. This is a 
clear, yellow secretion that is rich in proteins, fats 
and minerals. It is the same fluid that may have 
leaked from the mother's nipples during pregnancy. 
Colostrum is only produced in small amounts, and 
provides all the baby's nutritional needs as well as 
containing high levels of maternal antibodies and 
lactoferrin, which has antimicrobial activity. 



Mature breast milk begins to be produced 
around three days after birth, and the breasts start 
to fill. There are two types of breast milk. Foremilk 
is the first milk to come out of the breast at each 
feed. It is thin and watery, high in lactose and 
quenches the baby's thirst. Hindmilk follows, 
which is thicker, rich in fat, more nutritious and 
satisfies the baby's hunger. A baby needs both 
types of milk so it is recommended they feed fully 
from one breast before changing to the other. 

Duration of feed varies, but during the first few 
weeks a baby should be fed around every two to 
four hours. Mothers should be advised to follow 
the baby and their individual needs. A breastfed 
baby cannot be overfed. 

Mothers who worry their newborn isn't getting 
enough milk may be reassured that as long as their 
baby is producing eight to 12 wet or soiled nappies 
over 24 hours, is passing soft, yellow stools, 
gaining weight and is calm between feeds, they are 
feeding well. 

Problems associated with 
breastfe sding 

Engorgement Most women experience some 
degree of breast engorgement when their milk 
comes within a few days of giving birth. The 
breasts become swollen and hard, may appear red 
and hot to touch and can feel very sore. With 
regular feeding the amount of milk produced 
adapts to the needs of the baby and this problem is 
usually resolved. On occasions when the mother is 
unable to feed her baby, such as when she is ill or 
during weaning, these symptoms may recur. 
Encouraging the baby to breastfeed on demand 
while properly positioned is the most effective 
method of treating and preventing engorgement, 
as well as most other feeding problems. 
Alternatively, engorgement may be relieved by 
expressing a small amount of milk by hand or with 
the aid of a breast pump. 
Mastitis/blocked ducts It is common for 
breastfeeding mothers to experience blocked milk 
ducts at some point. A red, sore patch on the 
breast develops. Usually the blockage may be 
cleared by altering the position in which the baby 
feeds, creating a more satisfactory latch to draw 
properly from the breast. The mother should be 
advised to start each feed from the affected breast, 
as this is when the baby sucks hardest. Expressing 
some milk may also clear the blockage. A warm 
flannel or cold cabbage leaf inside the bra will ease 
discomfort and gently massaging the breast while 
feeding may also help. 

In some cases the pool of milk behind the 
blockage may become infected and mastitis 



18 Zhemist ■■Druggist 04.09.10 



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develops. Staphylococcus on the mother's or 
baby's skin enters a cracked or sore nipple and 
spreads into the breast tissues, causing a painful 
hot red patch and flu-like symptoms. If caught 
early treatment is with antibiotics such as co- 
amoxiclav or cephalexin. The mother should be 
encouraged to continue breastfeeding or 
expressing to relieve the pressure. Infections may 
lead to an abscess, which requires surgical 
drainage. 

Sore/cracked nipples Many women find that 
their nipples feel sore when they first start 
breastfeeding If they go on to bleed or crack, it 
usually indicates a problem with the latch. To 
achieve the correct latch the baby should take 
the whole of the nipple and most of the areola 
into its mouth. 

Rubbing a few drops of breast milk or applying 
a smear of white soft paraffin or purified lanolin 
to the nipple aids healing. Paracetamol or 
ibuprofen may be safely recommended to ease 
discomfort but it is important the breast is still 
drained, either by feeding or expressing, to prevent 
engorgement. 

Thrush Once breastfeeding is established any 
unusual nipple or breast pain may be caused by 
thrush infection. Thrush usually only affects the 
nipples, causing soreness and giving them a pink or 
red shiny appearance. In some cases it may spread 
into the breast along the milk ducts. This is known 
as ductal thrush and can cause deep pain within 
the breast, although it is common for the mother 
to experience no symptoms at all. 

If thrush is present in the mother it is often 
present in the baby. Symptoms include a 
reluctance to feed and white spots in the mouth, 
which reveal a raw area if rubbed. Miconazole is 
the treatment of choice for both the mother and 
baby, who should be treated at the same time. 
Oral fluconazole is often prescribed in more severe 
infections but is not licensed for this indication. 
Leaking breasts Many women find that milk leaks 
or sprays from their breasts when they are not 
feeding. This tends to occur when the breasts are 
full and may be brought on by the sight of a baby 
or hearing a baby's cry. It can be an embarrassing 
problem which may lead to the mother giving up 
breastfeeding. Breast pads are available to place 
within the bra to absorb any leaks. They should be 
changed once they become damp to prevent the 
growth of bacteria. 

Diet 

Breastfeeding uses around 500 calories a day, 
which should come from a healthy balanced diet. 
The DH recommends breastfeeding mothers take 
a daily supplement of 10mcg of vitamin D. There 
are no foods that must be completely avoided 
while breastfeeding but it is advised that oily fish 
intake is limited to two portions a week and, as 
with all adults, no more than one portion of 
swordfish or shark be eaten a week (due to their 
high mercury content). 

It is important to maintain a good fluid intake, 
although caffeine intake should be reduced as its 
presence in breast milk causes irritability in the 
baby. Alcohol also passes into breast milk, so it is 
recommended mothers stick to the same 
guidelines that exist for alcohol intake during 
pregnancy - no more than one or two units 
consumed once or twice a week. 




Babies should be exclusively breastfed for the first 
six months of life, the DH and WHO recommend 



Nicotine is present in the breast milk of 
mothers who smoke, who should be advised to 
stop smoking. If the mother chooses to continue 
to smoke, she should be advised not to do so 
before a feed to reduce the baby's exposure to 
nicotine. 

Very little information is available on the safety 
of breastfeeding while taking medication. Most 
drugs pass into breast milk, but the majority of 
OTC and prescription medicines are considered to 
be compatible with breastfeeding. However, there 
are a number of drugs whose presence in milk is 
known to be harmful and whose use in 
breastfeeding is contraindicated. These include 
codeine, amiodarone, iv/oral chloramphenicol, 
long-term course tetracyclines, lithium, high dose 
vitamin D, aspirin and ginseng. Some drugs affect 
breastfeeding itself by inhibiting the infant's 
sucking reflex, such as phenobarbital, or by 
affecting lactation, for example bromocriptine. 

Drugs that are commonly used in infants or 
have a history of use in breastfeeding are a good 
choice. 

If a medication is deemed necessary but is 
contraindicated in breastfeeding, it may be 
possible to delay therapy or temporarily withhold 
breast milk. If absolutely necessary it may be 
advisable to stop breastfeeding. 




Many women believe that breastfeeding protects 
against pregnancy. The lactational amenorrhoea 
method (reliance on the absence of periods while 
breastfeeding as a form of contraception) is 
thought to be 98 to 99 per cent effective. 
However, this is only true if the baby is being 
breastfed on demand, without supplements or the 
use of a dummy and the baby is less than six 
months old. Its effectiveness is reduced beyond 
six months as weaning starts. To completely avoid 
the risk of conception additional use of condoms 
or a diaphragm may be recommended. The 
mother must also bear in mind that ovulation and 
therefore pregnancy may occur without first 
having a period 

As oestrogen suppresses lactation, combined 
oral contraceptives are contraindicated while 
breastfeeding. The progestogen-only pill may be 
used safely from three weeks post-delivery. 

There will come a time when the mother will wish 
to reduce or stop breastfeeding. If the mother is 
returning to work, it is not necessarily the case 
that breastfeeding has to end. By law, employers 
have to allow mothers time to breastfeed their 
baby, although this is not always practical. Breast 
pumps are available to express milk from the 
breast, which may then be fed to the infant via a 
bottle or cup. This enables the child to receive all 
the benefits that breast milk provides without the 
mother actually having to be present, and may be 
an option for women who need to be away from 
their child for short periods of time. 

If it is decided to stop breastfeeding altogether, 
the baby should be changed to an appropriate 
formula milk, or cow's milk if over 12 months. It is 
recommended breastfeeding is gradually reduced 
by dropping a feed every few days to reduce the 
risk of engorgement, with milk production ceasing 
completely within weeks. 

Katharine Gascoigne is a part-time locum and 
pharmacy writer. 

successfully complete the 5 Minute Test for 



Other sources of information 

www.nhs.uk/Conditions/Breastfeeding 
i www.nctpregnancyandbabycare.com 
www.laleche.org.uk 

i www.babycentre.co.uk/baby/breastfeeding 

s www.laleche.org.uk 

• Regan, L. Your pregnancy week by week. 

London: Dorling Kindersley 2005. 

i www.nhs.uk 

c www.breastfeedingnetwork.org.uk 



NEXT WEEK 

Top tips on how to improve 
medicines adherence 



04.09.10 



19 



CLINICAL 



BUSINESS 



PROFESSIONAL 



^ 18 Breastfeeding ~W 20 Cracked heels ^ 22 Women's health ^ 26 Working with big pharma 



How does the constitution of foremilk and hindmilk 
differ? What are the symptoms of mastitis? Which drugs 
are contraindicated for breastfeeding mums? 

This article describes breastfeeding and includes 
information about milk production and common 
problems such as engorgement, mastitis, sore nipples 
and thrush. It also discusses diet, contraception and the 
safety of taking medication while breastfeeding. 

■ Find out more about breastfeeding on the Clinical 
Knowledge Summaries website at http://tinyurl.com/ 
breastfeedingOL 

Find out more about breastfeeding problems such 
sore nipples, mastitis and thrush from the NHS Choices 
website at http://tinyurl.com/breastfeeding02 and 
http://tinyurl.com/breastfeeding03. 

Read more about diet during breastfeeding and how 
some foods may affect the baby on the Babycentre 
website at http://tinyurl.com/breastfeeding04. 

Read the information about the safety of drugs in 
breastmilk on the Breastfeeding Network website at 
http://tinyurl.com/breastfeeding05. Print out any 
leaflets that may be useful for your patients. 

• Revise your knowledge of contraception during 
breastfeeding on the CKS website at 
http://tinyurl.com/breastfeeding06. 

Are you now familiar with breastfeeding and the 
problems that can occur? Could you give advice about 
sore nipples, mastitis and thrush? Could you advise 
about taking medication whilst breastfeeding? 



C minute test 

wJ What have you learned? 

est yourself in three easy steps: 

Itepl 

[ister for Update 2010 and receive a unique PIN number 



cess the 5 Minute Test questions on the C+D website at 
:hemistanddruggist.co.uk/ mycpd 



our PIN to complete the assessment online. Your test score will be 
corded. If you successfully complete the 5 Minute Test online, you will 
e able to download a CPD log sheet that helps you complete your CPD 



Registering for Update 2010 costs £37.60 (inc VAT) and can be done easily 
at www.chemistanddruggist.co.uk/update or by calling 0207 921 8425. 

Signing up also ensures that C+D's weekly Update article is delivered 
directly to your inbox free every week with C+D's email newsletter. 

Get a CPD log sheet for your portfolio when you successfully complete 
the 5 Minute Test online. 



What's the best way to treat cracked heels? 




At the Update Pharmacy, a middle- 
aged woman has been perusing the 
foot aids section for some time and 
is looking rather confused. Hannah, 
senior medicines counter assistant, 
has noticed and approaches her. 

"Hello Mrs Dunstone," she says. 
"Can I help you?" 

"I'm looking for a good cream for 
sore heels and I don't know which 
one of these to choose," Mrs 
Dunstone replies. 

"Is the skin cracked?" Hannah asks. 

"A bit, but you can have a look for 
yourself, I've got no tights on and 



I'm wearing backless sandals," says 
Mrs Dunstone, bending a leg up 
behind her. 

Hannah takes a look and says: 
"You've got a quite a lot of hard skin 
and a couple of quite deep cracks 
there. I think you ought to have a 
word with Mr Spencer. Take a seat in 
our consultation area over there and 
I'll send him out to you." 

"What I'd like to know," Mrs 
Dunstone says to pharmacist David 
Spencer as he is examining her heels, 
"is how I've come to get this. I think I 
look after my feet quite carefully." 

"Well," David replies, "it's a bit like 
if you push down on a tomato from 
above. It tries to expand sideways 
and eventually the skin cracks. That's 
what happens to the pad of fat 
under your heel as your body weight 
pushes down on it. 

"Having dry skin makes cracking 
more likely, and there are several 
other contributory factors. I'll tell 
you about those and we'll see if we 
can find you something good to 
treat it with." 

1 . What factors contribute to the 
likelihood of cracked heels? 



2. What treatments for cracked 
heels are available from the 
pharmacy? 

3. When should cracked heels be 
referred to a doctor or podiatrist? 



1. Drying conditions, eg warm 
weather, central heating. 

Predisposition to dry skin 
conditions, eg atopic eczema, 
psoriasis. 

Paradoxically, wet skin from 
excessive sweating or spending a lot 
of time in water, which lowers 
tensile strength of skin and 
predisposes to cracking. 

Wearing open backed shoes - no 
support provided to prevent heels 
from spreading under downward 
pressure from the body. 

Diabetes, causing autonomic 
neuropathy; hypothyroidism, 
causing lowered metabolic rate. 
Both lead to reduced sweating and 
dry skin. 

Peripheral vascular disease, 
causing loss of skin elasticity. 
• Excessive weight, increasing 
downward pressure on heels. 

Prolonged standing, especially on 
hard floors. 



' : Thin soled shoes. 

C1 Foot conditions, including heel 

spurs and flat feet, which affect gait. 

2. Emollients, used regularly, to 
rehydrate the skin - several products 
are marketed specifically for cracked 
heels. Ointments, being more 
occlusive, may be preferable to 
creams. Wrapping clingfilm over the 
heels further increases occlusion. 
Some products contain urea to 
increase hydration. There is also a 
hydrocolloid based product. A 
pumice stone can be used to reduce 
the thickness of hard skin. 

3. When OTC products are 
ineffective. 

• If fissures are deep, painful to 
stand on or bleed. 



Got an idea for a Practical 
Approach scenario or would you 
like to write one? Email your 
suggestion to: haveyoursay@ 
chemistanddruggist.co.uk 

For more Practical Approach 
scenarios, go to www.chemist 
anddruggist.co.uk/practical 
approach 



20 



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i 18 Breastfeeding 4 20 Cracked heels ' : "r : 22 Women's health \p 26 Working with big pharma 



CATEGORY FOCUS 



Women's health 

Make sure your pharmacy is equipped to deal with women's health conditions 
and you could capitalise on this lucrative market. Kathy Oxtoby reports 



Pharmacy is often the first port of call for 
women for healthcare advice, more so 
than for men, according to the results of 
last year's Department of Health consumer 
research. The research also showed women will 
often visit the pharmacy not just for themselves, 
but for their partner's and their children's health. 

"Compared to men, women tend to take a more 
active role in their health," says Elaine Evers, 
pharmacy manager at Lichpharm Midcounties 
Co-operative Pharmacy in Staffordshire. To build 
on that customer loyalty "community pharmacy 
must reinforce a caring image and ensure their 
customers recognise them as a one-stop shop for 
all their health and beauty needs", advises Rob 
Jackson, UK pharmacy shopper based design 
manager for P&G PharmacyCare. 

Pharmacists also need to be up to speed with 
the fast pace of change in women's health 
products. Increasingly more medicines are 
becoming available without a prescription; for 
example, tranexamic acid is now available 
through pharmacies under the brand name 
Cyklo-F, for women with a history of regular 
heavy menstrual bleeding. 

As well as being knowledgeable about the 
women's products they sell, pharmacists should 
also offer further advice and information as 
appropriate, advises Ms Evers. "There's a lot of 
confusion and misinformation about women's 
health conditions out there, so pharmacists can 
help by giving evidence-based advice on treating 
or reducing symptoms of women's health 
conditions, such as the menopause, or by checking 
that cystitis remedies are suitable for the 
individual patient." 

Pharmacists are also well placed to identify 
warning symptoms - such as pain or bleeding 
after intercourse - and to signpost women to the 
appropriate source of support, such as their GP or 
family planning clinic, says Boots pharmacist 
Angela Chalmers, who manages the multiple's 
Holloway Road branch in London. 

As well as focusing on symptoms and cures, Ms 
Chalmers stresses the importance of giving 
lifestyle advice to women. "It's not just about 
offering tablets - it's about 'how can I add to the 
quality of life of this woman through, say, advice 
about nutrition or by looking at their emotional 
wellbeing?'." 

She adds: "As pharmacists we should never 
underestimate the power of giving customers 
good advice. The woman you spend time with 
who wants a discreet word about a condition will 
trust you and tell her friends." 




m 

Sanitary protection market value 



6.2% 



Rise in pharmacy's share of feminine 
care/lubrication jelly market 



£44 



xiim 

I Pregnancy test kit market value 

I Source: SymphonylRI, 52 weeks to July 11, 2010 



■mi ■ ' ■ 'ijie word 

Discretion is a key word for women's healthcare, 
agrees Emma Charlesworth, Numark's retail 
excellence manager. "Feminine health is 
sometimes a bit of a taboo subject, and is often 
seen as quite an embarrassing topic to discuss. 

"Always remember that your customers may 
also be feeling this strain so remember to be 
discreet and compassionate." 

Women may feel embarrassed talking about 
common complaints such as thrush and cystitis, 
so Ms Chalmers advises pharmacists to promote 



the consultation room as a place where women 
can discuss these and other health issues in 
private and in confidence. Pharmacists should also 
ensure staff are trained to be discreet and to be 
empathetic with their customers so they 
understand what they are comfortable discussing, 
she believes. 

"Some women are fine to ask for a combi thrush 
treatment over the counter, while others don't 
particularly want to use the T word, so you need 
to gauge what their needs are," she says. 

Pharmacies can also play a vital role in raising 
awareness about such sensitive conditions like 
cystitis. According to Angela Lloyd, marketing 
manager for Actavis UK - which last month 
launched a digital and social media campaign for 
its cystitis brand Cymalon - the condition is an 
"untapped market where consumers are dealing 
with it in different ways not realising that there is 
treatment out there". 

Many women expect pharmacies to stock 
specialist products to meet their needs, says 
Susan Woodhead, category insight controller at 
Lil-lets. "Within sanitary protection, this may 
mean those women with heavy periods, older 
women, women post-birth or mums seeking 
advice for daughters," she says. Ms Chalmers 
stresses the importance of pharmacy having the 
right selection of all different flow types and of 
stocking big brand products that customers can 
buy while doing other medicines shopping. 

Women's categories, P&G's Mr Jackson advises, 
should be located away from the men's section to 
enable men and women to browse the relevant 
fixtures without embarrassment. Pharmacists may 
also want to create a women's or beauty section, 
with associated categories, such as skin, hair 
cosmetics, feminine care and fertility, he suggests. 

Effective displays 

Given that the women's health category is 
particularly sensitive, "effective merchandising is 
essential when considering the customer and 
making self-selection as straight forward as 
possible", advises Ms Charlesworth. 

Key subcategories should be positioned within 
either the P or GSL medicines section within a 
women's health category, she suggests. 



For women's health tips and more 
case studies, see C+D's website 

www.chemistanddruggist.co.uk 



22 Chemist Druggist 04.09.10 



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CLINICAL 



^18 Breastfeeding 



Market changes 2009-10 
Cystitis 



Total market value 

£4,701,425 4.1% 



Pharmacy* 

£3,227,278 

Grocery 

£1,439,785 



6.8% 
3.2% 



Feminine care/ 
lubrication jelly 



Total market value 
£25,489,086 1 .9% 



Pharmacy* 

£16,289,439 

Grocery 

£8,940,655 



6.2% 



5.1% 

Pregnancy test kits 



Total market value 

£44,128,556 

Pharmacy** 

£11,102,990 

Grocery* 

£32,121,468 



2.1% 
16.6% 



3*8% 



Ovulation test kits 



Total market value 

£5,418,498 

Pharmacy** 

£622,054 

Grocery* 

£4,796,444 



0.2% 
24.8% 

4.8% 



Sanitary protection 



Total market value 

£258,743,328 

Pharmacy** 

£13,194,489 

Grocery* 

£209,726,528 

Other outlets 

£35,822,311 



3.2% 

16.4% 

2.1% 

3.1% 



includes Boots and Superdrug 
**excludes Boots and Superdrug 



Source: SymphonylRI Croup, 
52 weeks tojuly 11,2010 



SymphonylRI 1 



CLINICAL BUSINESS PROFESSIONAL 

^ 20 Cracked heels W 22 Women's health !/ 26 Working with big pharma 



Pharmacists should always merchandise GSL 
products on open display to facilitate self- 
selection. "You may not realise how many 
customers you are actually losing through them 
simply not being able to find an appropriate 
product and being unwilling to approach the 
counter for advice," she says. 

But Ms Charlesworth adds that the fact that 
many of the more effective preparations tend 
to be merchandised behind the counter "lends 
itself nicely to support interaction with the 
customer - enabling community pharmacists to 
play to their strengths". 

She suggests pharmacists might also consider 
dual siting some of the GSL products within other 
female health categories; for instance, 
merchandising cystitis treatments alongside the 
vaginal care products within the sanitary 
protection category. This may instigate additional 
impulse purchases from long-term sufferers. 

By having effective displays, stocking a wide 
range of products and ensuring that staff have 
knowledge, insight and sensitivity about the 
female health category, pharmacists can build 
loyalty and boost footfall. And by offering women 
lifestyle advice they can also make a positive 
difference to their health and wellbeing. As Ms 
Chalmers says: "You might be offering a female 
customer information about something she 
doesn't want to hear, or something she's never 
even thought about, but that information could 
change her life." 



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Case study 




SHAFTESBURY 
PHARMACY, 
I IARROW 

LILATHAKERAR 
The contractor 
shares her 
experience of 
boosting sales in 
women's health 



When we recently increased the size of our 
pharmacy by four times its original size to about 
3,000 square feet, we established a pregnancy 
testing room away from the front of shop. 

The idea was to give a clinical feel so that we 
could take urine samples away from the rest of 
the premises. 

Women can complete the necessary paperwork 
and wait for the results of their sample in privacy. 
We then talk to them about the results of their 
tests in a sensitive way and in a professional 
environment. 

We also have a consulting room where we can 
assess women's inquiries about such sensitive 
issues as thrush. We set up this room as we know 
that privacy is a big issue for women - we 
regularly carry out customer surveys that 
show women value a private place to discuss 
healthcare issues. 

We've also completely re-arranged the layout 
of our women's section. We've arranged our 
displays to avoid embarrassment for women 
so that they can walk directly towards their 



options and pick up a product. 

Personal hygiene, menstruation and sanitary 
protection are in a centre aisle where women can 
easily identify these products, while pregnancy 
and ovulation testing are under the till so people 
can easily find them. 

As a regular writer about the menopause, I 
leave laminated copies of my articles on display in 
the window notice board for people to read, and I 
also leave copies out in my consulting room so 
that customers know what products are available. 

These days women put more emphasis on 
looking after themselves, and since the new 
pharmacy contract, we need to have a more 
clinical outlook and must ensure we provide our 
female customers with a professional service. 



CPD Reflect • Plan • Act • Evaluate 



Tips for your CPD entry on women's health 

REFLECT Are my patients getting the most 
out of women's health products? 

PLAN Review my and my staff's 

knowledge and sales protocols 

ACT Read this article, revise women's 

health topics such as cystitis, 
review available products and 
arrange training if necessary 

EVALUATE Do my patients get better advice 
on managing women's health 
issues? 



24 040910 



Rowlands' Kenny Black talks about a new retail vision at the C+D Conference 
www.chemistanddruggist.co.uk/thepharmacyshow 



Clearblue Digital Pregnancy Test 
with Conception Indicator 



BUSINESS 



First Response Early Results 
Pregnancy Test 



Manufacturer: P&C 
Classification: GSL 

: pregnancy testing 
USP: Clearblue says this 
product remains the only 
home pregnancy test 
capable of both telling a 
woman if she is pregnant and indicating when 
she conceived 
Ceuta Healthcare 
Tel: 01202 780558 



Format/pack size: 15ml 




For Pip code and RRP, please see C+D Monthly Price List or 
www.cddata.co.uk 



Antistax Healthy Leg Capsules 



antistax?. 




Manufacturer: Boehringer 
Ingelheim 

For: avoiding tired, heavy 
and achy legs 
Active ingredients: 
Flaven, a red grape vine leaf 
extract 

Clinically proven to 
help avoid swelling of the 

lower legs and feet when taken for four to six weeks 
www.antistax.co.uk 



Format/pack size: 50/100 



Pip codes: 276-6558 (50); 289-6918 (100) 



RRP: £7.99; £14.99 



Canesten anti-fungal range 

Manufacturer: 
Bayer 

For: anti-fungal 
treatment 
What's new: 
packaging 
redesigns on-shelf 
from last month, 
including an 
updated logo for 

consistency and greater shelf stand-out 
www.canesten.co.uk 
Ceuta Healthcare 
Tel: 01202 780558 




r formats, pack sizes, Pip codes and RRPs, please see C+D 
onthly Price List or www.cddata.co.uk 




Manufacturer: 

Church & Dwight 
UK 

Classification: GSL 
For: At-home 
pregnancy testing 
Mode of action: Detects the 
pregnancy hormone HCC in urine 

The company says it can detect a pregnancy six days before a missed 
period, unlike any other tests, including digitals 

What's new: Church & Dwight UK is launching a brand new advertising 
campaign this autumn, featuring the Early Results Pregnancy Test. The 
campaign will: run across major music radio networks from September to 
October; appear in leading women and mother and baby titles from 
August to November; be supported by a campaign on Facebook 
www.tellsyoufirst.co.uk, tel: 01303 858821 



Format/pack size: single/double 



Pip codes: 010-3283 (single); 017-2098 (double) 



RRP: £7.75; £9.75 



What are the best-selling women's health brands? 



Answers online at www.chemistanddruggist.co.uk 



® 



Health Aid 

Discover the Secret to 
Female Sexuality 




www.HealthAid.co.uk 



04.09.10 



25 



ZONE 



CLINICAL CLINICAL BUSINESS PROFESSIONAL 

18 Breastfeeding 4, 20 Cracked heels ^ 22 Women's health ▼ 26 Working with big pharma 




^-D Senate 



The new community pharmacy think-tank 



TOPIC: Forging a partnership with big pharma 



Stock shortages and supply deals have affected relationships 
with drugs firms. The C+D Senate investigates what a more 
dynamic relationship could deliver. Max Gosney reports 



The Senators 



Angela Chalmers 

Pharmacist, Boots 

Debby Crockford 

Area manager, Rowlands Pharmacy 

Hilary D'Cruz 

Partner, Ansons Solicitors 

Andrew Derham 

Commercial and supply chain manager, 
AstraZeneca 

lan Facer 
Chairman, NPA 
Keith Howell 
Pharmacy manager, 
Delmergate Pharmacy, Kent 



National sales manager, Actavis 

Mark Koziol 

Chairman, Pharmacists' Defence 
Association 

Nick Lowen 

Director of commercial operations, 
GlaxoSmithKline 

Gary Paragpuri 
Editor, C+D 
S1 eve Poulton 

Director of commercial operations, Pfizer 

David Reissner 

Partner and head of healthcare, 
Charles Russell 



mm 

THE C+P SENATE 

IN ASSOCIATION fj^ . 

with v actavis 

It might not have been plain sailing so far but big 
pharma and pharmacy can make a happy couple. 
That was the heartfelt sentiment after candid 
dialogue between the two sides at the C+D 
Senate. 

Both pharma firms and pharmacists admitted 
to past mistakes and accepted they'd not always 
communicated with each other properly. But 
despite their differences both are determined to 
make it work. 

Manufacturers view pharmacists as key to their 
goal of ensuring patients get the best out of their 
products, says Senator Steve Poulton, Pfizer 
commercial director. "One of the things we 
recognise is that where pharmacy can provide a 
route to better use of the medicine then we 
should definitely support that." 

Mr Poulton cites Pfizer's pharmacy-led vascular 
health checks as an example. "We've been talking 
to PCTs, saying this is something you should be 
commissioning and we believe pharmacy should 
be the vehicle." 

Improving medicines compliance is a huge 
opportunity for partnership, says Senator Nick 
Lowen, director of commercial operations at CSK. 
"Better use of medicines is going to be key to 
what the NHS wants to achieve." CSK has looked 
to help pharmacists fine tune MURs around the 
disease areas that are key to its medicine 
portfolio, like asthma, Mr Lowen explains. The 
pharma company has provided training support 
and practical tools around the condition, he says. 

Yet experiences of working with big pharma are 
not always rosy. "I had discussions with one large 
company in my LPC," reflects Senator lan Facer, 
NPA chairman and independent pharmacy owner. 
"But that hasn't really borne fruit. The problem we 
had in realising that was around funding and how 
it was commissioned." Overall, the relationship 
between big pharma and pharmacy remains fitful, 
the NPA chair reflects. 

Stock shortages haven't helped, warns Senator 
Debby Crockford, area manger for Rowlands 




Pfizer's Steve Poulton: "We don't want big pharma to 
become the last funding resort for pharmacy" 

Pharmacy. "There's a lot of anger in some areas 
over shortages. Those poor guys at the coal face 
have to deal with the patients who don't 
understand why they can't get hold of a medicine.' 

Another flashpoint has been bespoke 
manufacturers' supply deals. These have been 
blamed for a rise in paperwork among 
pharmacists. Yet many drugs firms say the 
schemes were driven by a desire to get closer to 
pharmacy customers So what's happened to 
achieve that? "It's interesting because it takes two 
to get closer," Mr Poulton reflects. "We don't 
want big pharma to become the last funding 
resort for pharmacy." 

Mr Poulton cites projects with national chains 
like Rowlands and independent pharmacy 
operators as evidence of success. "It comes down 
to having an adult-to-adult relationship between 
two commercial organisations," he says. "Have we 
been successful with every pharmacy in the UK? 
Absolutely not, but we're further down the road 
than three years ago." 

Forming those thriving relationships could be as 
simple as getting together more often, Mr Poulton 
concludes. "You can't work together unless you 
get together." Forging closer links with LPCs could 
be a way to build bridges, says Ms Crockford. 

AstraZeneca (AZ) has introduced pharmacy 
champions into its regional teams to build links, 
reveals Senator Andrew Derham, commercial and 
supply chain manager at AZ. As part of building 
stronger relationships, AZ has also held meetings 
with pharmacy, GPs and nurses, which Mr Derham 
adds, "have helped us to gain insight and have 
generated great engagement". 

A more drastic step towards successful 
partnership may require a more fundamental 
change, according to Mark Koziol, PDA chairman. 
He suggests splitting the national pharmacy 
contract into two: one contract for dispensing and 
the other for providing clinical services. He says: 
"You could then create thousands of pharmacists 
whose eyes and ears are open to clinical services. 



Watch the Senators speak out on building links with big pharma. 
Video interviews at www.chemistanddruggist.co.uk 



Pharma and pharmacy 
working in tandem 

AstraZeneca's Making the Most of your 
Medicines (MMM) scheme 

An own-brand MUR that paid pharmacists to 
perform reviews on patients taking key AZ 
drugs. The scheme was halted this March 
after two years, with high overheads and 
inconclusive results to blame, according to 
AZ's Andrew Derham. "We learned a lot from 
MMM. The scheme demonstrated 
improvements in some patients but also 
showed that the administrative burden for 
pharmacists in terms of training, paperwork 
and contracts, in addition to the patient 
consultations, can be a real challenge in a 
i project like this." For the future, the challenge 
remains for pharmacy chains and 
manufacturers to simplify the process. 

Pfizer's vascular health check programme 

Pfizer has provided a complete kit for 
pharmacists to launch a health check service 
I as part of the government's vascular 
screening service. Over 95 per cent of 
patients praised the pharmacy checks in a 
pilot of the scheme. The DH has also backed 
the scheme, yet Pfizer has struggled to get 
mass buy-in from PCTs due to the disruption 
caused by the white paper and trust's 
financial constraints, says Pfizer's Steve 
Poulton. 

CSK's asthma MURs 

A 2009 pilot in Hampshire and the Isle of 
Wight showed asthma sufferers improved 
their understanding and management of the 
condition after consultation with a 
pharmacist. Forty seven pharmacies took part 
and were provided with training and auditing 
support by GSK. 





Rowlands' Debby Crockford: "Poor guys at the 
coalface have to deal with patients who can't get 
hold of a medicine" 



PDA's Mark Koziol: split the contract into services and 
dispensing for a "huge, great, dirty, big win-win" 

That's something pharma can engage with in 
enabling them to deliver. . . It's a huge, great, dirty, 
big win-win." 

Yet some remain unconvinced that splitting 
pharmacists from medicine supply would be 
beneficial. Mr Facer says: "Once you split supply 
function from clinical elements you start to 
struggle. If you take that supply function away 
you have less opportunity to influence the clinical 
side of it." 

There is a huge future in collaborative working 
with big pharma, the NPA chair says, and the two 
should focus on delivering the priorities set out by 
the government for the NHS. But with the white 
paper light on detail, deciphering what these are 
remains a guessing game, Mr Facer adds. 

Until that clarity arrives there is much the two 
sides can get started on, says Mr Lowen. The 
government has been clear on its Quality, 
Innovation Productivity and Prevention (QIPP) 
agenda. For pharmacists that translates as 
adoption of treatment guidelines for asthma, and 
following up on patients with COPD. 

But more must be done with the invaluable 
data that comes from MURs, say grassroots 
pharmacists. "When we do MURs we come out 
with some amazing stuff," says Senator Angela 
Chalmers, Boots branch manager. "I sometimes 
feel like my consultation room is a confession box. 
I can almost look at a patient and know the issues 
they'll encounter with a drug. Wouldn't it be 
wonderful if there was a feedback mechanism to 
share this with you?" 

Achieve these closer lines of communication 
and the future is bright. The relationship with big 
pharma has had its rocky spells but, as Ms 
Chalmers concludes, it's a potentially unstoppable 
partnership. "CPs have been landed this job of GP 
commissioning and a lot of them don't know 
where to start. If pharmacists and drug companies 
work together, there's some direction. Otherwise 
where is pharmacy going to stand in the future 
when it comes to getting services?" 



. Big pharma and 
pharmacists have a 
common goal: getting 
patients to take medicines 
properly. 

2. Open dialogue between 
both sides is needed. 
Communications are 

fused as big pharma 
es a plethora of 
irmacy bodies; industry 
presentatives must give a 
ore coherent message to 

:gs firms about what 
harmacists can offer. 
Pharmacists want to see 
drugs firms attend LPC 
meetings. 

3. Both sides must take a 
positive approach to 
partnerships. Big pharma 
should not be seen as a last 
resort for funding. 

A. Big pharma and 

pharmacists must identify 
immediate opportunities 
for joint working around 
QIPP agenda. 

5. Both sides should 

investigate how invaluable 
MUR data can be used to 
shape future service 
opportunities. 



CPD Reflect • Plan • Act • Evaluate 



Tips for your CPD entry on working with 
big pharma to develop services 

REFLECT Do i work productively with 
manufacturers for the benefit 
of patients 7 

PLAN Consider ways to build closer 
links with manufacturers, eg 
invite reps to your LPC meeting. 

ACT Implement your initiatives by 

discussing your ideas with reps 
and/or your managers. 

EVALUATE Have my relationships with 
manufacturers improved and 
have patients benefited? 



04.09.K 



71 



JOBS 



Hundreds more jobs online 
www.chemistanddruggistjobs.co.uk 



0207 921 8123 



Booking and copy date 
12 noon Monday prior 
to Saturday publication 
subject to availability 



Contact: Andrew Walker 
Tel: 0207 921 8123 
Fax: 0207 921 8132 
andrew.walker@ubm.com 



Chemist+Druggist 
Ludgate House 
245 Blackfriars Road 
London SE1 9UY 



PHARMACIST/ 



i 



1 



SUPERINTENDENT PHARMACIST I 

1 

S 

8 
M 
K 
I 

1 

I 

I 



(Two Posts) 

PRESTON 

Salary excellent + benefits 

Pharmacists with a strong ethical and service focus 
required for this exciting new venture. 

Contact: Hazel at hazelhughes22@aol.com 
or Tel: 07830 005736 after 6prn 



SALES MANAGER 

Pharmaceutical/Healthcare 
Package negotiable London (South) 

An established and leading niche pharmaceutical and 
healthcare products company is looking for an experienced 
professional to head up a new marketing department and take 
responsibility for sales and a small sales team. 

The successful candidate will, in addition to possessing skills in 
consumer marketing, be an innovator in his or her approach 
to new product launches, design and consumer and trade 
advertising and promotion. Although not absolutely essential, 
you have probably worked in the industry and have a good 
knowledge of retail pharmacy and pharmaceutical wholesaling. 

As this is a new position we are looking for an individual who 
understands the inextricable relationship between sales and 
marketing and has excellent communication skills to develop 
the role both internally and externally. 

In return, the Company is offering a comprehensive package 
with the great potential to grow with this exciting business. 

Please send full details/CV to: 
P. ©. Box No: 8 S 23, Chemist and Druggist, 
Ludgate House, 245 Blackfriars Road, London SEI 9UY 



POLARSp 

X. THE 



THERM0LOG1ST1CS 



Polar Speed Distribution Ltd is the country's foremost 
pharmaceutical distribution company. We operate a private 
pharmacy from our head office in Leighton Buzzard, 
Bedfordshire and now wish to recruit a 

Pharmacist/ Pharmacy Manager 

to take control of the operation. You will be responsible for 4 
part time Pharmacists, 10 full time Pharmacy Support Staff and 
4 part time Patient Liaison staff. 

Terms and Conditions for the chosen candidate will be excellent. 

Please submit a full C.Vto: 

Mrs J Rae 
Polar Speed Distribution Ltd 
8 Chartmoor Road, Leighton Buzzard, Beds LU7 4WC 



Pharmacy Manager - Shropshire Border 

Pharmacy manager or long term locum 
required for village pharmacy. 

* Short working week of ONLY 32 hours, but can be flexible. 

* No week-ends. Half day Wednesday. 

* No MUR's. No pointless paper-work. 

* Excellent salary package offered to right candidate. 

* Five weeks per year or more by negotiation. 

Contact Adrian Edwards on 01624 837893 
or e-mail adrian_edwards@manx.net 



Derby 

Pharmacy Manager/ 
Pharmacist 

Negotiable + excellent 
benefits + flexible contracts 

Please contact Alison Hanson on 
02476 432 1 7 I or email your CV to 
Alison.hanson@lloydspharmacy.co.uk 



Lloydspharmacy @) 

Healthcare for life 



Nottingham 

Pharmacy Manager/ 
Pharmacist 

Negotiable + excellent 
benefits + flexible contracts 

Please contact Alison Hanson on 
02476 432 1 7 1 or email your CV to 
Alison.hanson@lloydspharmacy.co.uk 



Lloydspharmacy @) 

Healthcare for life 



28 



rugPisi 04.09.10 



3 Birkbeck 

^ UNIVfcRSITY OF LONDON 



Jobs updated daily over 500 online now 
www.chemistanddruggistjobs.co.uk 



Sheffield 

Pharmacy Manager/ 
Pharmacist 

£negotiable + excellent 
benefits + flexible contracts 

Please contact Alison Hanson on 
02476 432171 or email your CV to 
Alison.hanson@lloydspharmacy.co.uk 



Lloydspharmacy (^j) 

Healthcare for life 



Coventry 

Pharmacy Manager/ 
Pharmacist 

Negotiable + excellent 
benefits + flexible contracts 

Please contact Alison Hanson on 
02476 432171 or email your CV to 
Alison.hanson@lloydspharmacy.co.uk 



Lloydspharmacy @) 

Healthcare for life 




Our pharmacists are an integral part of the 
community. 

Enthusiastic, Driven with Excellent communication skills. 

We are looking for experienced pharmacists for these two 
busy dispensing branches. Providing a wide range of ad- 
vanced and enhanced services. 

Are you looking for a new challenge? An excellent 
remuneration package? The chance to make a 
difference in your community? 



Contact: 
Katriona Guerin 
0208 2566 222 

katriona. guerin(« davlewisplc.co.uk 



day lewis 

Pharmacy 




Clinical Pharmacy Update Course for 
Pharmacists/Pharmacy Graduates and Nurses 

17th October 2010 from 9.00am to 4.00pm. 

Medicines Administration Course 

18th September 2010 from 10.00am to 1.00pm. 

Venue: St Heliers Hospital, Post Graduate Medical Centre, 

Wrythe Lane, Carshalton, Surrey SMS 1AA. 
For further details please contact Course Director: Mitta Bathia 
Tch 07947 764158 Fax: 020 8640 1918 
Email: mittsbfa vahoo.co.uk 



www.chemistanddruggistjobs.c 



Dispensing Assistant/Technician 
Required - Part or Full Time 



Working tow ards or qualified lo 
NVQ level 2 or 3. the ideal 
candidate will base the right 

experience to can s out a 
supervisory role in our new 
pharmacy located at The Flitwick 
Surgery. Flitw ick. Bedfordshire. 

The closing date tor this application 
is Frida\ Kith September 

For an application form 
please email 
highlandspharmacy@hotmail.co.uk 



Birmingham 

Pharmacy Manager/ 
Pharmacist 

Negotiable + excellent 
benefits + flexible contracts 

Please contact Alison Hanson on 
02476 432 I 7 I or email your CV to 
Alison.hanson@lloydspharmacy.co.uk 



Lloydspharmacy ^) 

Healthcare for life 



Technicians Wanted 

• UK Wide "S**^ 

• Full Time or Part Time Hours 

• Earn Extra Income on Days Off 

• Local or Stay Away Bookings -+ 

0800 33 45 098 

Loc : Dispensers 



04.09.10 



29 



CLASSIFIED 



Advertise your service here 
Call 0207 921 8123 



the legal prescription 



Cost effective specialist legal advice 
to independent retail and community 
pharmacies 

We can assist with buying, selling, merging 
and demerging pharmacy businesses as 
well as related leases, sales and purchases 
of commercial premises 



ANSONS 



UP 



Solicitors 



Contact 

Hilary D'Cruz or Jas Singh 
01543 466 660 
info@ansonsllp.com 
www.ansonsllp.com 



0207 921 8123 

Contact: Andrew Walker 
andrew.walker@ubm.com 




<6 



I Hi III' h HI . HHullliil. j 

Accredited courses for pharmacy 
support staff: 

• Medicine Counter Assistant course 

• Level 2 for Dispensing Assistants 

• NVQ3 in Pharmacy Services 

• Checking Courses 

• Pre-registration Pharmacist Programme 

• CPD Academy for all support staff 

• Funded Advanced Apprenticeship 
programmes (age restrictions apply) 

New for 2010: 

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Enrol any time and experience our supportive learner 
journey with 24/7 helpline and access to learner 
management system. 

For more details see our website or telephone 
01 15 9374936. 

One of our friendly team is always 
available for advice. 



t: 0115 937 4936 
e: training@buttercups.co.uk 
j www.buttercups.co.uk 



CD 



Chemist+ Druggist remains the clear leader 

in influencing stock decisions* 
*Linda Jones Associates Industry Survey 2009 



Mundays has a long history of 
dealing with clients involved 
in the pharmacy sector. 

We offer pro-active advice on: 

• all aspects of pharmacy 
acquisitions and 
disposals by asset or 
shares including all 
related property matters 

• relocation of pharmacies 
and pharmacy appeals 

joint venture and 
consortium arrangements 
and agreements 

Please come and visit 
our stand at the 
Pharmacy Show 2010 
stand No. F120 



mundays 



"Mundays have significant 
experience and knowledge, 
practical and commercial 
awareness and an enthusiastic 
and approachable style" - 
Chambers UK Guide 2010 




KNIGHTS 



Letting Customers Down? 

Knights Fragrances will deliver 
anywhere in mainland UK the NEXT 
WORKING DAY. 
We WONT let you down! 



Visit us at: www.knights-fragrances.co.uk 



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At last, the practice mortgage that gives you the freedom of 
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NO WHOLESALER GUARANTEE REQUIRED 

30 YEAR TERM AVAILABLE 

FREEDOM FROM WHOLESALE AND BANK 
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Contact George Knox on 
0191 2584645 / 07963 375383 



I'm II I SMI IN M 



30 



list- -Druggist 04.09.10 



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ELECTRICAL • HEALTH A BEAUTY 



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CD 



04.09.10 rug2ist31 



Looking to buy or sell a pharmacy? Advertise here 

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32 



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Advertise your service to community pharmacy every Saturday 
Call 0207 921 8123 




(5) Concept, design & planning 
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www.rapeed.co.uk • 0800 070 0102 



Pharmacy design and shopfitting 
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w: www.njlyorkline.com 

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NIL VORKLINE 



ARE YOU A 

LOCUM 

PHARMACIST? 




modiplus provides the following 
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"4.09.10 



PEOPLE 



Got a story for Postscript? 
postscript@chemistanddruggist.co.uk 




V \ 

le Victorian Pharmacist 




Buttercups Training hits the high seas 



Buttercups Training has swapped dry land for a 
boat on the River Trent to raise more than £2,500 
for charity. 

Members of the Buttercups Training team took 
part in the Nottingham Riverside Festival Dragon 
Boat Challenge last month. 

The team took the title of charity winners for 
raising the most money as well as the trophy for 
the best dressed team. 

Money raised from the event will go to the 




Rainbow Hospice for Children and Young People in 
Loughborough. 

Preparations for the race included male 
members of the Buttercups team waxing their legs 
to boost fundraising efforts. 

They also joined their female team mates 
wearing bright yellow t-shirts and green tights 

Managing director of Buttercups Training 
Vanessa Kingsbury said: "We all had a fantastic 
day and we were delighted that we won all of our 
races despite some serious competition. We had 
tremendous support from our staff and friends 
and family who came along on the day and I 
would personally like to thank everyone for their 
efforts and achieving a great result." 



C+D reader of the week 

Meet Raj Patel, of Mount Elgon Pharmacy, and find out how he 
juggles pharmacy with cooking and playing his PSP. 



What was the name of your first pet? 

Reggie, a silver shark. 

What's the best thing about your day? 

Waking up in the morning with my girls, and 
looking forward to seeing them in the evening. 

And what's the worst thing? Not having 
enough hours in the day to complete all my 
tasks ... or time to play on my PSP! 

What one thing about pharmacy would 

you change? I'd ensure access to patients' 
clinical records. 

What is the biggest change in pharmacy since 



you qualified? Enhanced and advanced services. 

What's the best dish you can cook? 

My girls call me Celebrity Masterchef - I seem 
to be a dab hand at everything. I just throw 
everything together and it always seems to work! 

Who would play you in a movie about your 
life? Myself! I want to be a Bollywood superstar. 

What should we ask the next interviewee? 

What is the craziest thing you have ever done? 

Calling all pharmacists and technicians. We 
want you to be our reader of the week. Email 
us at postscript@chemistanddruggist.co.uk 




The Victorian pharmacist's medical 
suggestions obviously shouldn't be taken 
seriously - they came from a round-up 
of medical journals published in C+D in 
November 1884. Have you ever used a 
remedy that would be chuckled at now? 
Let the Victorian pharmacist know: 
postscript@chemistanddruggist.co.uk 



The C+D Conference 

^ NEC Birmingham 10-1 1 Oct#er 20f 



All sessions will use interactive voting 
technology to allow audience participation 





Andrew 
emplo 
Confei 
explaii 



Speakers include: 



lan Milburn 
Former Health 
Secretary 

What the white 
paper means to 
NHS services 



Helen Cordon 

Chief Executive 
RPSCB 

Five challenges 
facing pharmaci: 



Michael Cann 

Chairman 
BGMA 

Making the most 



from generics 




Duncan Rudkin 

Chief Executive 
The CPhC 
Life under the 
new regulator 




Andy Murdock 
Pharmacy Director 
Lloydspharmacy 
A multiple's view of 
the new look NHS 



Mark James 

Managing Director 
AAH 

Wholesaling, big 
pharma and you 



Chris Brooker 
Business Director 
Co-operative Pharmacy 
Learning from the Co-op 
blueprint for success 






question for any of the speakers? Email it to haveyoursay@chemistanddruggist.co.uk 



SIGN UP FOR YOUR FREE TICKET AT 



ACTIVE 
INHAIAHON 



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Nicorette Inhalator Product Information: 
Presentation: Inhalation cartridge containing 10mg nicotine lor oromucosal 
use via a mouthpiece Uses: Relieves and/or prevents craving and nicotine 
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the success rate Those who have qurl smoking, but are having difficulty 
discontinuing their Inhalator are recommended to contact their pharmacist 



or doctor lor advice. Contraindications: Children under 12 years and 
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& lactation: Only after consulting a healthcare professional Side effects: 
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1 728. 2. Leischow SJ. et al. Am J Health Behav 1996; 20(5): 364-371 

Date ot preparation: August 2010 2813 



For every cigarette, there's a